Friday, January 29, 2010

Friday is the new Monday

Don't panic, you didn't oversleep by 3 days.

It really is Friday.

However, the good Dr. G is increasing his smarts at a conference today and asked me to blog for him.

Haven't the guest blogs been great. Makes me want to return to dental school and move to Canada. OK, I'm kidding about the dental school part - just writing that made my eye start to twitch. The Canada part I'm serious about. It is really interesting how different dentistry can be on the other side of an imaginary line.

Well, as I sit here at home writing this blog it is 15 degrees outside and a dusting of snow is on the ground. The forecast for tomorrow at Noon CST is for 18 degrees. That matters not to you, I understand, but to me tomorrow's forecast is important because that is Plunge Day: the day I hurl myself into a public lake raising money for Special Olympics. I will have pictures on Monday's blog. In the meantime, here is the funniest polar plunge I have ever seen - it's like Punk'd on an international scale.





I love Fridays, have I mentioned that before. I'm off on Fridays and so is Susan, so when the kids are in school we get to spend lots of time together on Fridays. Of course, when I say I am "off" we business owners mean "not seeing scheduled patients" because I am almost always in the office on Friday. Paying bills, cleaning off my desk, organizing the office, seeing emergencies. You don't work less as a business owner, you just don't have someone telling you to work more. But the work never really ends.


You ever have one of those weeks where you feel like you spent the week having to be the boss? What I mean is, most weeks the office runs smooth, everybody does their job, patients come and go with happy smiles and no complaints. Then you hit weeks like this one. Staff needs some redirection (don't say that to a patient, don't change the schedule without asking me, etc.) and patients get confused about their bills and how insurance pays. Those weeks are exhausting.


I am what I consider to be a common-sense manager. I hire employees that have a good work ethic and common sense. If they run late one morning, I don't have to pull them into the office and explain the importance of being on time - they know and it doesn't happen again (remember I have 4 operatories in 1400 sq. ft. and 5 staff - we get to talk to each other a lot).

However, there are some things that employees do that fall into the category of "business owner common sense". Those are the things I have to address with them individually and quickly because they have no concept of why what they said or did is wrong.

For instance, apologizing to patients for the "crazy schedule" when the patient was seen on time and left on time - they never saw the running around behind the scenes ("pay no attention to that man behind the curtain, I am the great and powerful OZ"). Or wanting to change the schedule because they don't understand concepts like payroll costs versus production (i.e., I don't need 2 hygienists waiting around for a set of patients that can be seen by 1 hygienist).


It is at times such as these that I am glad that I can honestly say that I never ask my staff to do anything that I have not done. Sometimes they forget because they were not here in the beginning before I had a hygienist. I went 18 months doing my own perio. I had days where I saw 10 new patients or had 3 patients scheduled in 2 chairs over 70 minutes for 3 routine exam/cleanings and they were in and out on time.


It can be done.


It may not be fun and I may not want to do it every day, but it can be done.


People don't always realize that sometimes the most exhausting part of owning a small business is being the cheerleader: Motivating your staff to work smarter, to stay energetic, to make sure patient care comes first - all while presenting an air of calm. Employees may say TGIF - but so do business owners, albeit for different reasons.


have a great weekend,


ric

Tuesday, January 26, 2010

Just a lot of nothing

I know it is Wednesday and you are expecting great stuff from me. I have had 5 days to think about today.
I have a couple of things to say, but not much, so here goes.

I finished the book A Million Miles in a Thousand Years by Donald Miller.
I started reading this book because a guy I really like recommended it to me. He said it was life changing. I finished it and nothing. I was waiting for this epiphany and my life to change but nothing. It was like reading his journal. Like he would sit down at the end of the week and write a chapter about what he learned this week. It just started and then it just finished. No plot, no real climax, it just was.
So now that I am finished I am going to see this guy again, and he is going to ask me what I thought. When a guy says the book is LIFE CHANGING and I don't remember a thing about it, what do I say to him. I think I am going to lie.
Now along the same lines is I brought him my book The Glass Castle and told him that this was my favorite book of the year. And I went to him two weeks later and he said he hadn't started it yet.
Now I have lent this book to 3 people and not a single person liked it. I was like these people are idiots. That book was unbelievable.
So he told me last week that he downloaded the book and is listening to it on his iPod.
I said, "Oh" like I knew what he was talking about.
Please someone tell me what he meant. Can you go to itunes and download a book?
Aren't we losing the whole reason for having books? It is called READING not LISTENING.
I am reading a book called The Last Lecture.
I think I told you about it. It is a short book and a real easy read. I will have it finished by Friday.
Speaking of Friday, I will not be here. I am going to see Dr. Bill Strupp in St. Pete. It is all day Friday and all day Saturday. It is called Simplifying Complex Cosmetic and Restorative Dentistry (that is, I am banking on one day doing a complex or restorative case again).
Dr. Ric is on for Friday so the blog will go on.
Then on Saturday I am rushing back to Orlando for MONSTER JAM at the Citrus Bowl.
This year my daughter wants to go. So I am going and I am taking 4 children.
I will tell you about it next week. I will bring my camera.
So I don't know if I have told you but my daughter Madison is something special. I don't necessary have a favorite but if I did...
She is very smart (I am not joking when her pediatrician told us she was very advanced and we should consider finding her a special school) and very self-motivated.
So when you start getting older and you are looking at your kids and trying to see who is going to be successful enough to take care of you, Madison is my bet.
She comes home and does her homework with no issues. I ask her to do something and she does it. She likes to read and understands herself. For example, when she is tired she says, "I am going to bed" even though it might be 6 pm (and she goes to bed at 8:30).
Now when we are talking about her future, I am always talking about big stuff. For instance, she said she wanted to own a pet store when she gets old (she loves animals), I will say something like, "Why don't you first become a veterinarian and then buy your pet store?"
On Saturday my wife went to Costco and took Madison along and you can imagine my surprise when Madison came home and made a big announcement...."I know what I want to do when I grow up."
I said, "Awesome, what is it?"
And she pumped out her chest and said, "I want to man one of the food sample booths at Costco."
I did the best I could and said, "That is so awesome, you are going to be so good at that."
$75,000 in private school education before college and these are her aspirations.
Maybe it is time for a parent/teacher get together.
Speaking of parents and teachers. My son, Luke, you know the self-proclaimed "awesome" kid, is having an issue.
He was so upset last night. He claims that his teacher is being mean to him and picking on him.
Now we have come to a crossroad in our parenting.
Do we say, "Damn that teacher. How dare her be mean to this kid who we think is the best kid in the world"? Or do we say, "Luke, I am sorry dude. It is time to buck up and deal with it.
Now I am the ladder type of parent.
I became that way because I always had to deal with my own problems when I was in school. My parents cared but I was kind of self-sufficient. See my parents were spending most of their time dealing with my rebel older sister. So when I had a teacher that "didn't like me" there was no going to mommy and telling on the teacher.
Now my wife is the exact opposite. She wants to go running to the teacher and ask her what is up.
So there was a lively discussion at the dinner table last night. My wife tells Luke that she is going to talk to the teacher and I say, "What are you going to say?"
Luke was telling us that the kids get together and they are asked to keep their voices down and work together. So, my son, while crying (tool of manipulation) tells us that while he was imploring his group to quiet it down and he was getting on them about not working together she pointed him out and took him out of the exercise.
Now probably what happened is Luke says to the group, "HEY WE HAVE TO STOP PLAYING AROUND AND WORK!" while they were suppose to working quietly. He was being loud, plain and simple. It doesn't matter what he said...he got busted.
Now what he hears from the teacher is, "I don't like you and I think you are a brat so get out."
Whose fault is it? Well it's Luke's. If he doesn't want to be busted for talking too loud then he shouldn't be loud. I don't care if you are praising Jesus, just do it quietly.
And Luke, like I said before, is a "golden child" and a master manipulator. This is a deadly combination.
He does most things half-ass and tells you he did it. Go clean your room. He goes into his room and comes out in about 30 seconds. You go in his room and one piece of clothing has been moved, not cleaned. But if you ask him, he would say that he cleaned his room.
So his impression of what happens is very tilted toward Luke.
But this being said, most kids want an advocate. They want to know that their parents are going to back them, go to bat for them.
I mean, I want that.
So somehow we have to let Luke know that we love him and will always be there for him but just not this time. Who knew parenting would be so hard. And I think it is going to get harder.
For instance, I had a parent come in and her 19-year-old daughter is in college three hours away in Boca. She said she had to go to the hospital last week. She said her blood pressure was up. She was having heart palpitations and stuff. She went to the emergency room and they didn't find anything after all sorts of tests.
Then again last night she was having the same kind of symptoms. So what is at the top of your diagnosis? Let me remind you of the story...19-year-old away from her family for the first time, at college. DRUGS. Maybe NoDoz or some Sudafed. Or maybe some greenies or some reds.
Maybe she got drunk for the first time, but who knows.
I asked the mom, "Is she doing any drugs?"
And of course she said, "No, she doesn't do anything like that."
YEAH, RIGHT!
Neither did I until I went to college.
I have said too much.

Have a great Wednesday.
John

Tuesday, January 19, 2010

New perspective

Hey all,
In our efforts for you not to get bored with just my (and Dr. Ric's)
writing I wanted to spice this thing up. I had the pleasure of getting a comment from a dental student and I jumped all over that.
I wanted to hear more about dental school. I wanted to hear what the professors were like. I wanted to hear how they are being educated. I wanted to hear if it is still dog eat dog like it was when I was in school.
This is this ghostwriters first time and will give us just the tip of the iceberg today. I am hoping this type of blog catches on and he/she will write for us and go into more depth next time.
Read it, I think you will like the style and the innocence.
I hope it brings you back to an awesome time in your life....now that it is over.

Hello!
To preface this post, let me start by saying that I am dental student.
Yes, you read that right, student. Maybe that brings back incredible memories of first patients, celebrating new life milestones with your classmates – birthdays, weddings and babies, or life-long friendships. Or maybe that makes you shudder thinking of late nights of studying, stressing over national board scores or trying to meet requirements. If you are of the former, hang with me, because those aspects of dental school haven’t changed. If you are of the latter, still hang with me, but those stressors still haven’t changed.
So why I am here?
The last week of December found me sitting down at a computer, taking my Part 1 of national boards. 400 hundred questions in 7 hours – you know the drill. For the past weeks leading up to my exam, I had been eating, sleeping and breathing with study cards and notes. My social life had waned and I had started to lose touch with what was going on in the outside world (I am only slightly kidding with that last statement.) With boards over and Christmas break upon me, I finally got to spend lots of quality time with family and friends.
One night I dragged out my computer to see what was happening in the real world and my other world – the dental world. Stumbling across this blog was one of the highlights of break. I fervently read through the archives, trying to see what dentists in the “real world” are up to.
As dental students, that is often one of the things we like to ask our professors and those practicing dentists – how are things done in the “real world.” In school, we learn to do things the textbook (read the long and stepwise way) because we need a solid foundation to build from, but students still love to find out how things really go down in practice. I digress.
So anyway, I sent this blog an email and here I am, today’s friendly ghostwriter. This is going to be a crazy busy semester with classes. Practicing dentists – do you even remember what some of your dental classes were? If you can, props to you, because I can hardly remember what I took in college…
Oral pathology, oral surgery, endo, dentures, cased-based learning and removal partial dentures are on deck, and you better believe I am fist-pumping excited about what I get to learn. That’s right – excited. Giddy, to say the least. Dental school continually becomes more competitive to get into, and each day I try and remember how lucky I am to be able to chase down my dreams of becoming dentist. On the days I see interviewees touring my school, I am always grateful that the “getting into dental school” phase of my life is over. At age 23, it has been a dream nearly 10 years in the making when I realized early in high school what I wanted to do with the rest of my life.
It seems fitting with it being 2010 to celebrate my almost 10 year anniversary of wanting to be a dentist with a group of those who care about dentistry. For those in practice and a student no more, maybe you breathed a sigh of relief that you are not in my scrubs. For those non dentists, you too probably breathed a sigh of relief that you are not in my scrubs because you don’t like saliva. Or needles. Or blood. At least you are still breathing and hopefully thinking of dreams in your life that you have accomplished or are on the road to accomplishing as well.
Thank you for reading and thank you to Dr. John for letting me share my thoughts.
May your 2010 be filled with blessings.

I loved that part of my life. People kept telling me these are the best years of your life and I didn't believe them. But now I want to go back. I want to go back to 2 patients a day. I want to go back to "that will be $25 for those 3 fillings" . I mean, I love my life now but those days were awesome.
I am so glad this ghost writer can bring me back. I hope you liked it.

Have a great weekend,
john

Ps If you live in another country and you want to give your opinion on dentistry we would love to have you.


Northern Exposure, Dental Style

Hey all,

Remember when asked all my non American dentist readers to write me. Well ONE guy answered the call and you are going to be so glad he did. I am so glad he did. Well I will let him tell you all about himself and where he practices.

My first blog...here goes nothing. I've been an avid reader of Dr. John's blog for well over a year now, and when he asked for volunteers for an international perspective on dentistry, I figured i'd give it a go. Not exactly exotic, but different.

I am Jamie Bumbac, a 33 year-old Canadian working in the northern part of the province of Manitoba (think 600 miles straight north of Bismarck, North Dakota). I've been practicing for the past 9 years as an associate/locum dentist in more than 15 different offices in western Canada. In my short career I've seen a lot. From artistically gorgeous work to “oh my god, you've gotta be kidding me” dentistry that would make you puke. The patients who brush once a year, I've seen it. So, here's my frank and interesting (hopefully) Canadian perspective on dentistry.

To start, I gotta dispel one big myth. Contrary to popular belief, all Canadians don't have government-funded dental care. When chatting with Americans and dentistry comes up, the assumption is that all Canadian dental care is covered under the blanket of “socialized health care”. (As a side note, Health Care Reform in the States is seriously interesting to follow on CNN these days...man, you guys are passionate about it! Most Canadian politics almost put me to sleep.) I do see how easily the assumption can be made. The fact is, Canadian dentistry is simply a fee-for-service industry, as it is in the States. The only Canadians with governmental dental coverage are Treaty Status Indians (and Inuit), as well as those people who qualify for Social Assistance (or Welfare Coverage, which is VERY basic). Status Indians must have a Treaty Card to qualify for the federally-run plan known as FNIHB, and yes...they are covered 100%. All minor dental and (with pre-approval from the plan, a lot of) major dental services are covered. Sounds wonderful, but by no means perfect. Just ask a First Nations person (the “politically correct” term for our aboriginal peoples) about waiting for pre-approval for RCT on a "hot" tooth for 2 months and then having to wait another 6 months to, possibly, qualify for a crown. Better than nothing, absolutely...perfect, nope.

Unfortunately, in the past, it has also been very easy to be unethical when dealing with this system. Not many dentists will tell you this (and I feel a bit “traitor-ish” saying it myself), but I get sick of seeing it over and over. Crappy dentists making huge amounts of money doing garbage, “drill and fill” work on these poor people. That is, if they actually DO the work. Very little accountability was put in place. Thankfully, committees are being set up and governing bodies are cracking down on these “disgraces to the profession”. I guess the government simply assumed that dentists would be honest and ethical when dealing with this coverage (I mean, we did take some kind of oath at graduation, didn't we?....hmmmm) How silly to assume.

Anyhow, I don't want to give the impression that Canada is full of rotten dentists. The opposite is true. People are people. I'm unfortunately very passionate about this topic because I'm currently in an area (north of the 53rd Parallel) where I deal with this system a lot, and I see more of the bad stuff than most. A typical, urban dentist in Vancouver, Toronto, Montreal, or Calgary might see what I speak of about once a year, if that. FNHIB is like most federally-run government programs...full of flaws and hard to change. It does, though, have potential to be a good system. Aside from FNHIB, a lot of people seeking dental care in Canada would have some type of 3rd party coverage, either from their employer or a personal insurance plan. It is then up to each office to either assign the benefits (bill the insurance directly), or not. The rest of our patients would simply fall under the category of paying for services out-of-pocket. We still battle the same issues with collecting payments, overdue accounts, and office overhead, as I'm sure most of you do.

I would say that dentistry in major Canadian and American cities is quite similar. Possibly the only differences that I can think of are fees (I would guess considerably lower here), advertising allowed by our governing bodies (stricter....no billboards, or 1-800-DENTIST here), a higher population:dentist ratio here, and much less litigation (I've never even considered being sued).

I hate to even admit this to John and Ric (who have admittedly had significant fallout from the recession), but I don't know many guys in Canada that have even blinked at the recession. One of the things that I hear quite often is that dentistry here is really very “recession-proof”. Smaller economic fluctuations, higher population:dentist ratio, lack of easily accessible specialists (therefore GPs do a lot more and refer less), and a high percentage of patients with 3rd party insurance, makes dental economics here pretty stable. I think we do pretty well up here for being socialists (cough, cough...wink, wink). I won't get too political, because I'm truly clueless when it comes to politics.

hmmmm....what else....

Everyone and their dog is looking to place and restore implants up here (topic for another day). Cosmetic dentistry and esthetics are front-and-center in a lot of CE courses. An ugly number of new grads seem to only see dollar signs (I'm getting old). Always wondering how to run a more efficient practice (bill more, work less, and do it well). I'd consider most Canadian dentists to be humble and reserved. I think a lot of Canada is still very under-serviced by dentists. And, I still consider the education I got to be as good as anywhere in the world. I'm a proud U of S alum (Saskatoon, Saskatchewan)!

So, that's Canadian dentistry in a very small nutshell. I'm an regular guy, doing regular dentistry, with regular issues....I've never even seen an igloo....I do say “eh!” a heck of a lot...I think American beer tastes a bit like water....I don't know your buddy in Toronto...I cheer for the Maple Leafs and hate the Red Wings!...I got depressed when the USA beat us in World Junior Hockey last week (not supposed to happen!)...I feel right at home in a Montana bar...I cheered for Orlando in the playoffs last year.....I love to curl....I still plug a bunch of posterior amalgams.....I like a strong American dollar....Las Vegas is like my second home....and, for the majority of the winter I really wish that I was Dr. John Gammachia in sunny, warm Florida!

Hope you enjoyed it....I'm spent!

I told you you were going to like it.
I have to admit, I was one of those people that believed that Canada had socialized dentistry.
And I didn't know anyone watched curling other than in the Olympics.
Great stuff, thank you Jamie, eh.

Ps What the heck is up with Canadian football?




Monday, January 18, 2010

Come on in, the water is freezing

Sorry, this post should have gone in yesterday but it wouldn't load - I know many of you were left unfulfilled.

I was talking to my son last night as I was putting him to bed and asking him what he knew about Martin Luther King Jr. Surprisingly, for a 3rd grader he knew quite a lot. I love that his generation is so completely baffled by the concept of racism - I'm not saying it is a dead issue, but it seems that each succeeding generation realizes Dr. King's dream a little more than the last.

As I was talking to him about the fight for desegregation his mind could not grasp the idea that parents and teachers (adults) would be screaming at little children trying to go to school. "Where were the Christians?" he asked. How do you tell a 9-year-old that they were right there behind the National Guard screaming obscenities along with the others. I know that racial issues tend to be politicized today but if we can all put politics aside, today is a day to embrace the fact that in our not-so-distant past some atrocious things were done by one group of people to another for no other reason than the pigmentation of their skin. The dream isn't accomplished but it is improving.





Now, one final comment on Dr. King. My son asked a very profound question, for which I did not have a good answer. He said, "Dad, if Dr. King thought education was so important, why are we out of school today?" Ah, the wisdom of kids.

What a good weekend. Busy but great. This was a soccer tournament/basketball weekend so my wife and I were very busy with kids stuff. I also spent the day on Friday running numbers from 2009 and seeing that, while we have definite room for improvement, it was a good year overall. I am excited to see what 2010 will do - the initial numbers are looking good.

As I mentioned last week, in 2 weeks I am paticipating in the Polar Bear Plunge. This is a fundraiser for Special Olympics. I have done this event for 3 years and each year I reach mid-January and start to wonder why I am agreeing to jump into water that is so cold they have to break the ice to clear a section of clear water for us. Then I remember the reason why I and hundreds of other do it - the kids.

I am so proud to belong to an organization (the AGD) that has a relationship with Special Olympics. If you have not taken the opportunity to work with those special people, you are really missing out. This is now a worldwide organization that truly embraces sport for sports sake.

I wonder many times as a parent of 3 healthy, athletically gifted children, how different my life would be if my children were not able to partcipate in sports. To see them succeed, set a goal and accomplish it - what a privilege. Parental pride, often-times bordering on hubris.

Special Olympics provides that opportunity to a group of parents that would not otherwise have that chance. The AGD provides dental care at the Special Olympics, and I believe that is one of the best outreaches we can do. I am doing my little part by throwing my overweight body into cold water for a few seconds and watching my kids laugh at me.

If you would like to learn more about the plunge, click here.

Thanks again for the privilege of letting me share my voices with you at the start of each week. I'm going to let them go to bed now.

Have a great week.

ric

Thursday, January 14, 2010

Post-op

Good Friday to you,

Don't have much going on. Now that I am not coaching I just sit back and be critical of all the other coaches. Oh my gosh it is so much easier.

I forgot to tell you on Wednesday that I did end up running last week.
It was 34 degrees and raining. I tell you that I hated it and loved it.
I hated the cold. I hated that my nose hurt and my fingertips hurt. But I loved that I was doing it.
I loved that I was disciplined enough to do it. I love that I love running so much to do it.
My wife thinks I am crazy, and I have to agree sometimes but I guess I haven't told her that I just like running.

Okay, I will get right to it.
If you just happened to come across this blog and you are just checking it out for the first time...well, I am sorry for what you are about to read. Yes this a dental blog, but sometimes we stray.
This blog is straying in a monumental way.
Keep reading. I am sure we will talk about teeth soon.
But today is going to be a following up on Wednesday's blog which was about my trip to the Urologist to have my vas deferens tied off.
Okay if you are not up to date, go back and read Wednesday's blog and then come back. Go. Go now... we will wait.
So I got home. I was in no pain.
My friend, who was the urologist, warned me of my feeling good and then doing too much.
I had my surgery on December 29th, smack dab in the middle of bowl season. I am no fool.
I did, however, plan a dinner at my house with my periodontist and his wife.
I thought it would be okay.
It was fun. They made fun of me, and we laughed a lot about it.
After they left I went straight to bed.
It was a little difficult to sleep just because I was afraid of hurting something.
The next day was a lazy day. I sat around a lot. I was able to get out and walk around, but really I am a pretty good patient.
But for the first full day I did not want to see what was going on down there.
But I had to come to terms with what was going on when I took my shower.
The incision was less than a centimeter long. I know there was one stitch in there, and I would be very surprised if there was two. But now everything is black and blue, and I mean everything, and swollen.
I remembered my urologist telling me stories of hematomas and out-of-control swelling. This is when it is not good to be friends with your doctor.
So I am looking down there, and it is black and blue and swollen. So I called him. I asked, "when you were telling me stories of "vasectomies gone bad", how black and blue is bad and how swollen is swollen?"
He talked me through it. He asked me if I was in any pain. I was in no pain but just concerned.
He said things sound very normal.
So for the next couple of days I took it easy. The bruising slowing went away, but I was swollen for 10 days or so.
You know being swollen down there is not that big of a deal until you sleep and roll over or if you are just talking and forget that you are only 4 days post-surgery and try to cross your legs.
HELLO.
So I had a post-op appointment 6 days after surgery.
Luckily, I had the same male nurse.
He was very nice and again very matter of fact when it came to male nakedness.
I walk in and he starts asking me about how I am doing and tells me to drop my drawers like it was nothing.
"What? Now!"
"Yeah, now. That is what we are here for."
So there I am again, naked as a jaybird, talking to him like it was nothing.
He tells me everything looks good. I get dressed.
Now the sample cups come out.
He is talking like we are talking about sports.
He says you are going to have to take a log of my "evacuations," (he used the more technical "E" word). I am trying to be cool. I am trying to act like this conversation is so normal.
So then he says if I participate in any "manual activity" (again, he used the more technical "M" word) you have to keep record of it.
WHAT?!!! Wo, wait a minute. Now you have stepped over the line.
We are not talking about the "M" word.
I was trying to be cool with the "E" word, but now you start with that.
That's the line and you just JUMPED over it buster.
He goes on to say that he needs the 21st sample and the 30th sample.
He explains, "You see there apparently is active sperm still in the system, and it will stay there for awhile. So you need two clean samples before we give you the all clear.
He is still talking as if he is talking about the weather.
Then I start thinking. I have to keep a log. 21st sample? I am 40 years old. Maybe things aren't as active in the bedroom as they were when we were 27 and my wife just had a baby 14 weeks ago and has him attached to her body 24/7, so the frequency might be a little down from that. Such is life.
Now all you 27 year old that are reading this....you will be there.
So sample 21 and 30, I was thinking how long do they keep records here? I wondering to myself if they are going to remember me when I come back with this cup thingy.
I just laughed. I mean these are things we have to go through in life. We get crazy stuff done to our bodies. Vasectomies, face lifts, facial peels, veneers, root canals, bladder lifts (I know about this because I have a staff of 9 women), gum surgery, tooth implants....all this stuff. It ain't fun, and regardless of how much I try to make my patients laugh or try to make them think about something else, it's still probably not that fun. But we have to do it.
And the stuff that we talk about seems so "matter of fact" to us. But you have to remember that sometimes it feels weird to the patient. Sometimes it feels like they are naked as a jaybird and we are explaining uncomfortable and awkward procedures to them as if we're just talking about sports.

What an experience.
Life is going to throw so many lemons at you.
For crying out loud make lemonade.
Have a great weekend.
I hope I made you laugh these two blogs. I know it wasn't about teeth but I was hoping my experience would make us closer.

Have a great Friday.
John

Next week, we are going to have a student write a blog entry. I was thinking that it would be nice to get a different perspective.
And in February, Black History Month, I am working on setting up an interview with an African-American Dentist. I want to know more and I want you to know more about people. I think this would be a good start.
If you have ever wanted to know more about the African-American culture and were too shy to ask....send me your questions at Jgammichia@aol.com

Tuesday, January 12, 2010

Under the Knife

Hey all,

Okay, this week Luke had me laughing.
Now you may know Luke is 10. He is my complainer. He is always complaining about something or someone.
I guess he might get it from me.
But we are driving in the car going to church on Sunday, and we see a family that we know in front of us. And we are commenting on the people in the car and how the kids are growing up and all three of them are squished in the back seat.
We are mentioning all the kids by name and age, and when we get to the youngest kid in the car, who is Luke's age, he has some comment about them. He say something about how this person is a pain or something like that.
Then we start giving him a hard time about not liking anyone. Then we say, "What do you think people would say about you if they were looking in our car?"
He thought about it a second and said, "There is Luke. He is so awesome!" He wasn't kidding.
I was going to say that it's great how kids think of themselves. They think they are the best and that they are so awesome and that everyone must love them. But I think we all think of ourselves this way.
"There is John. He is so awesome!"

I finished the book The Help. It was very good.
I started Donald Miller's (he wrote Blue Like Jazz) new book A Million Miles in a Thousand Years. I know it is going to be a quick read. I really like his witty humor and style.
I think it is about how he edited his life. I am just getting into it, but he has been asked to take one of his books about himself and write a screenplay from it. This time make it "less boring."
So I think it is going to be a funny way of "living your life to the fullest."
And next on the list is The Last Lecture. This is about a guy who is a professor at Carnegie Melon University who lectures for a living. He had a lecture planned about "how to get the most out of life" (or something like that) and found out before the lecture that he had 3-6 months to live. So he had to give his last lecture. He was 41 years old. I am looking forward to that.

I watched The Hangover again. My wife and I saw it at the theater and we laughed. We saw it again on Sunday night and we laughed all over again. You think the movie is going to be really sophomoric and crude, but it really isn't (except at the very very end). It is just funny.

I heard Avatar was "so awesome" or "the best movie I have ever seen" from a couple of my peeps at church. So with that filter I took Luke out with one of his friend to see it (Luke received an awesome report card, so we went to Steak-n-Shake and he got to see a movie).
Well the movie was good, but it wasn't for a 10 year old. There was a lot "G.D.s" and "Jesus." There was a "mating" scene and a lot of violence. It wasn't that bad, but when I am concerned about what my son is watching I can't enjoy it.
Then, of course, there is a nation of people that worship a tree and their whole life is sustained because they are one with the tree. So we had to have a discussion in the car about how trees are good but NOT our God. And I had to hear a lot of "I know dad" and "I get it dad."

Okay,
Now is the time to turn off your TV sets if you are squeamish at all. If you don't like talking about body parts scroll to the top and hit the "X".
I am going to talk about my trip to the Urologist and what's like to be on the other end of a procedure.

First, I will tell you why.
My wife and I are both 40. Is that the only reason? No.
My wife and I have 4 awesome children (most days at least 3 of them are awesome). Is that the reason? No
Our last kid took us 3 years to have and let me tell you it was a miserable experience (two babies dying in utero and nine very long nail-biting months to have David). Is that the reason? No.
But if you put them all together, I thought I wanted to have this done.
I love kids, and if they didn't cost any money or if it wasn't a big deal that I was 80 years old at their high school graduation I would have a bunch more but....
My wife said she would go along with any decision I made.
I made my decision (it also helped that I had already paid my $4800 deductible for the year and the procedure was going to be "free").
So the decision was made.
I run with 3 urologists. I just had to pick which one I wanted to handle this delicately.
I picked the one that was young (2 years out of school), passionate, and hungry and very nice.
I would have preferred some more years under his belt, but he seemed to be the most like me.
Passionate and willing to take the time to do it right. And I thought he would care the most for me and my delicate parts.
So I called him up and told him that he was going to be the chosen one. He told me about the procedure, and he asked if I was sure I didn't want one of his partners to do it (he works in a group of 12).
I said, "Why would I want anyone else to do it."
He said, "Because if you have a problem with me taking care of your junk (his words not mine)."
I said, "Listen, you are a urologist. You have seen so much junk that anything that I have is not going to be something you haven't seen before."
He said, "Sadly, you are right."
I mean, the guys works on penises (or is it peni) all day long. I hope mine looks like the rest of them. If I am going to do it, I am going to do with a guy I know and like. I bring this philosophy to my practice as well. I want my patients to like me and respect what I do so that they know I will do the best work I can for them.
This brings me to the day of the appointment. I have a 4:15 pm appointment.
Remember this my Christmas break so I had lots of shopping to do. I have a normal day.
I am not really thinking about it. I know I have to be home to get a shower in and leave enough time to be there early.
The office is like the Taj Mahal for vasectomies. It is so nice.
I was called back in a couple of minutes. I see all the guys I know from running and they all say hello and give me the "I know what you are here for" smile.
I was escorted into the room by a male nurse.
Okay, so here is the thing. To you, the patient, this is something you are nervous about, you are nervous about the shot, you are nervous about the post-op. You are nervous about exposing your "junk" to people you don't know.
But to them, it is like a walk in the park. You walk in, they exchange pleasantries with you and tell you to get naked. No big deal to them. I am a little embarrassed, but remember I am on Valium and I don't care that much.
I am lying on my back and he puts a patient napkin over my junk, then rips a hole in the patient napkin and pulls everybody through.
I am thinking, is this really happening? This is just standard procedure.
Then my doctor walks in. Iodines me up and gets to work.
Okay so how do you think an anesthetic shot for a vasectomy feels?
I had my root planings done a month ago or so, and I tell you being on the other side of the needle in your mouth makes you empathize more for your patients. It makes you a better dentist.
But I lose all my empathy, when people are getting an injection in their vestibule and saying they feel it, because now I have had two shots in my most sensitive area.
So he is doing his thing, and he is talking to me about running and Gator sports. And all this time you can tell he is doing something but I am not able to feel it.
Surreal.
He finishes up and goes to the other side of the room. By now they have taken everything off me, I am still lying on my back and they have put a 4 x 4 piece of gauze over the body part of the moment.
The doctor walks out and it is me and the nurse again.
He tells me to get dressed and gives me my instructions.
So I put on my underwear, then my compression underwear (which they require you to have) and my jeans, OH and my bag of ice.
I am thinking it went pretty good. I mean he did some clamping when it wasn't numb but he quickly rectified that situation. I went back out feeling pretty good. I saw all my friends and joked about going home and loving on the wife and then wobbled to the car.
I went home thinking things were going to be a breeze.
Well I will tell you about being home on Friday.

Have a great Wednesday,
john

I noticed we have some readers in some other countries. I am interested in one of you writing a blog entry for us telling us what dentistry is like in your country. We would love to hear from you. If you are interested can you please write me at Jgammichia@aol.com

Monday, January 11, 2010

Push 1 for customer support, Push 2 for English

"The digital image software was not able to initialize, please contact High Tech support at . . ."

Yep, that's how I want to start my week. Good one God; didn't even have a chance to get some coffee.

Have I mentioned before that we are entirely paperless. Not a single chart. I couldn't process and mount a full-mouth series on F-speed film if you paid me. Well, that might be hyperbole, if you paid me I could do it, but it would need to be cash up front - and no insurance writeoffs, either - full fee.

That said, not having access to radiographs is a bit of a problem. Paper chart offices never have that problem. "Sorry doctor, but all of our radiographs are stuck inside the charts and we can't remove them...better call support." Now instead they get, "Doctor, the radiographs fell out of the chart and I can't find them, they weren't fixed long enough and are too dark to read, they are out being copied. . ." In 3 1/2 years, we have not had a single issue so this was a bit of a wake-up call this morning.

The fix, it seems, is nearly as nerve-racking as the problem. See to fix it, I have to call support (1-800-Seinfeld) and talk to some random person and then give this person access to my server. Now, I'm a dentist - not a tech guy - but I'm pretty sure the server is an integral part of my computer network and random people whizzing around, opening files, initializing processes, and typing DOS gibberish scares the daylights out of me. I have a friend who lost all of his material (I mean, 15 years + worth of records - everything financial and appointment related) to some phone service, let me in the server and I'll fix it easy guy. So I'm a little tense and my first patient has just arrived.

Thank you God, the problem is solved. Don't ask me what it was or how it was fixed. I don't know, it involved opening files that I never open and typing nonsensical letter strings onto a blank computer screen with a blinking "$". I'm just glad it is fixed and hope to not see any errors again for a long time.

OK, enough dental stuff. I had a great weekend. The kids had snowdays Wednesday, Thursday, and Friday so we got to spend lots of quality time together. My son discovered that I am better at the Wii than he thought an old guy would be (my Wii fit age is 26, thank you very much). My youngest daughter is going through a "I just want to hang out with dad" phase and it's awesome. She crawled up on my lap and wrapped both of us up in a blanket yesterday while watching the Cardinals Packers game and promptly fell asleep. I was "trapped" for 2 hours - Lassie, where are you?? Go get help boy, get mom. . .

This weekend also marked the start of Upward Basketball for my older 2 kids. If you are not familiar with it, Upward is a church-based basketball program that emphasizes fundamentals and fun. It has a few quirky rules, but it is designed to let the kids have a great time playing basketball. One of the best parts of the program is that each game begins with player introductions. Our church does it up - big time. Lights out, sirens going, music blaring, spotlights and all. I get to be the announcer at a lot of those games and, other than the dry throat; it is so much fun to see the kids get to be superstars for an hour.

It is amazing how much more fun life is when the bills for the week are paid.

Only 3 weeks till the "Polar Bear Plunge", you'll find out more about it next week but if you can't wait go here.

have a great week.

ric

Thursday, January 7, 2010

Christmas Party II

Opening up Christmas Pajamas


Reading the scripture verse first thing Christmas morning

No recession here

David, have you every seen a baby so cute?


Nothing going on this week.
Although, I have been busier than a one-armed coat hanger at work...which is a good thing considering I think everyone put a moratorium on dentistry in the month of December.

It was 30 degrees coming to work yesterday.
Now, I started to think about this. This is not that cold, but you see we have not been below freezing here in over 2 years. And it is in the 30s here for almost a week.
I don't even have clothes for this.
I don't have gloves, I don't have long johns. I don't have stuff for cold.
So what might not seem cold is cold if you are not prepared for it.
I go outside and come right back inside.
And of course, I just don't do cold very well.
I don't do icicles, especially coming from the snot in my nose.
I hate my feet being cold (I must have poor circulation), and if they are going to get cold I just won't do it.
I used to do white water rafting but my toes hurt so no more white water rafter (much to my wife's dismay, because she loves it).
I don't ski that often because it is so hard to get 6 pairs of socks and the ski boots on.
Yes, I know they make little warm packets, and I have tried but it just isn't warm enough.
But you know what I do do well....spring. 75 decrees....that is what I do well.

Anyway,
I wanted to tell you about our Christmas party.
It was very similar to last year. I have to tell you that our staff is really starting to gel.
I think morale was down because we lost some family members. It kind of sucks when you like working with people and then they are not there anymore.
So that whole thing was enough to get people down.
But we have been really stable for the last 4 months or so, and people were excited about the holiday and the vacation time.
Sometime in June we picked the day for the party, December 18th.
For the record that was a stupid move. Never have your Christmas party on the Friday before Christmas. Number one, everyone is trying to have their Christmas party on that day.
So that means if you have a staff of 9 someone's going to have a conflict. Someone's husband who has a job where he is in authority and he can't miss his party can't go to the party. And he can't go to his Christmas party without his wife. So she has to miss our party. I am not being sarcastic or am I blaming anyone, I am just saying it was a stupid move on our part.
I mean why not have the party the first Friday of December. This would cut out all frustration and the conflicts. I will start the Holiday season off, instead of getting in the way.
Mental note for next year.
So this is what we did.
We met at Bahama Breeze for happy hour.
First picture before I changed the night setting.
Appetizers and drinks. This restaurant is in the Mall parking lot. It is a stand alone building, but in the parking lot. So it is walking distance from the mall.
I have to admit that I am a cheap skate. I have told you this. They say, "I am tighter than two coats of paint". But this party is something I have always never worried about.
I enjoy my staff's company. I enjoy making them feel special.
So after about an hour or so at Bahama Breeze I give them all $100 and tell them to go to the mall.
The stipulation is, you have to spend all the money and it has to be for YOU. Not your daughter, not your husband, or anyone else...YOU.
There is a restaurant in the mall called The Elephant Bar. I tell them we have reservations at this place in one hour...GO.
We all split up (I use this hour to go shopping for my wife, which I told you I had not shopped for at all), do our thing, and meet back for dinner.
Dinner is where we eat, enjoy each other's company, and then show off all the gifts we bought for ourselves.
We had a really nice time. It is nice to be out with your staff because being cooped up in the office you start to each other are not real people.

We are a fun bunch. So much fun that whenever we go out all the servers from the restaurant are always saying how they want to work at a place like ours.
It was a great time.
It makes me think I really need to do fun stuff with the staff more often. You know that team-building stuff. I shouldn't wait for the Christmas party every year to not be a tightwad.
I shouldn't wait for Christmas to tell them how much I appreciate them.
I shouldn't wait for Christmas to tell them that I am a better person and dentist because I get to work with them.
Hmmmm, I feel a bowling party coming on.
Did you all have fun at your parties?
If you have a funny story, I would love to hear it.
If you had a disaster party, I would love to hear that too.
If you decided that the times were too tough and didn't have one, I want to hear your thoughts.
Have a great weekend.
They say that it might SNOW here tonight.
WHAT?!!! Are you fricking kidding me?

John

ps I got a vasectomy over the break, and I have been given the green light to talk about it. I have to keep it PG so I am really struggling with how much detail I can go into. It was funny stuff. I know you are going to be looking forward to next weeks blog.

Wednesday, January 6, 2010

Christmas Party

Hey Everyone. Happy New Year.
I have missed you. You don't have to say anything...I know you missed me.
I have so much to talk to you about. But today I am going to keep it short and sweet and tell you about our Christmas Party.
First, a couple of funny things.
I don't know if you know this or not but Florida is getting some unusually low temps. Today I was driving to work and it was 31 degrees. Now I know all you North people are laughing at me, but 31 is fricking cold to me. It is cold outside and dry inside. I know it is dry by all blood in my tissue when I try to get rid of all the crusty boogers in my nose (TMI, TMI).
But I will have you know I love the midday. It is so beautiful out at 2 p.m. 55 and sunny...awesome.
We had another Noah-ism yesterday, and I am still kind of cracking up about.
We are all sitting around the dinner table and my 9-year-old daughter wants to start talking about our New Year's resolutions. So we go around the table and I say that I want to stop yelling. I don't know if I have told you that when I hit my boiling point I yell, and mostly it is at my kids. I hate that I do it but.... So that is mine.
My 10-year-old son says that he wants to stop talking back. My 9-year-old daughter says she wants to stop nagging. And I thought that was very thoughtful of the two of them.
So my daughter asked Noah was his New Year's resolution is. And he asked, "What is a New Year's Resolution." So she says to him, "It is something that you want to improve on throughout the year." Noah thought for a couple of seconds and said, "Baseball." Man that kid cracks me up. I don't know if it is funny to you guys, but to me...hilarious.
Books
I finished Counterfeit Gods. Good.
I started and am liking a book called The Help. It is a fiction novel about the deep South in the late '60s. And how rich white people were virtually raised by The Help (hence the name). Some kids would love the help and then grow up and become mean to the help and others would continue to love the help even thought it was socially not accepted. I like it but I have to tell you that I have not had a lot of reading time, so it is slow going. I have a couple of books waiting so I'm trying to read this one as fast as I can. Donald Miller, who wrote Blue Like Jazz, has a new book, and that is next. I have heard it is "life changing." I bought a book called The Last Lecture that I am excited to read.
Movies.
My wife got me a ROKU. Anyone know what this thing is? It is basically for people that love movies. See I have Netflix. Part of the Netflix plan is that you can chose from 17,000 movies to watch instantly on your computer. It is kind of a pain to watch a movie on your computer, so if you have a wireless router, you can send the movies to this ROKU box and watch the movies from Netflix on your TV in HD. Nice. This could be why I don't have time to read.
I did watch a bunch of movies. I watched a bunch of family movies. We all watched It's a Wonderful Life together...it is the best. We all watched The Mighty Ducks together (see my kids figured out how to put movies on my Netflix queue, and if I don't check it I won't get a movie for me until June). On the ROKU we watched a movie with Jennifer Aniston in it called Management. It was okay. And I watched a movie called Cashback, a British film, that was good. And my last instant movie was called The Narrows. I liked this movie. Not awesome but pretty good.
Christmas.
The Gammichia family had a huge Christmas.
Christmas Eve is usually the big night in our family. See the deep-rooted Italian stuff is still deep. We do something called the Seven Fishes on Christmas Eve. My father and all the other deep-rooted Italian men stand in line at Lombardi's seafood at 5 a.m. on Christmas Eve morning to buy all the fish for the Christmas Eve feast. And a feast it is. But usually the feast involves seven types of seafood and lots of bread.
Linguine with Clam Sauce (1), Sconguilli salad (which is conch) (2), Fried shrimp (3), and Fried oysters (4). He makes a Sea Bass (5), Calamari (6), and he makes a Calamari stuff with crab meat (7). But it doesn't involve guns and the breaking of people's knee caps, at least not at our house.
This eating starts at about 5 p.m. and doesn't stop until Christmas night at about 9 p.m. We leave my father's at about 9:30 p.m., and then the kids open their Christmas pajamas, which they love, and then go to bed. My wife begins to cook breakfast for the next morning, and I run to the neighbor's to pick up all the big gifts like the bikes and basketball hoops. See Christmas morning is at my house. (I am the only Gammichia kid [it is me and my two brothers and two sisters] with kids). The kids open Santa's presents early in the morning. We tell them that if they wake us up before 7 a.m. then we take a toy a piece away from them.
So at 7 a.m. we start with the first present. The tradition at our house is the first gift to be opened is the Bible. We read the story of the birth of Christ out of the gospel of Luke and try to remind ourselves what Christmas is about.
Then it is chaos.
My family is supposed to come over at 9 a.m. and the whole family exchanges gifts. There are lots of people. See my mom and dad got divorced about 9 years ago. Since then both of them have remarried. So my mom comes over with her husband and my father comes over with his wife. So I have four brothers and sisters, and now my kids have three sets of grandparents. So at 9 a.m. it is the second round of chaos. The kids get gifts from all of them. They all exchange gifts.
Then my wife puts on this huge spread for everyone (about 14 people), mimosa to French Toast to bagels with lox.
Everyone looks forward to it.
Everyone stays at our house most of the day. This year 3 of my brothers and sisters taking my kids to the movies...Alvin and the Chipmunks, The Squeakual.
Then at about 7 p.m. my mom does Managotti at her house.
WOW!!!
A couple of thoughts...it is great to have family in town. I am blessed to have a family that has made it a point to live close by each other. I am blessed to have a wife that is so part of our family that I think they would take her over me any day.
This year I tried so hard to make Christmas not about getting gifts. My kids are so spoiled, but how can they not be. They get three gifts from Santa (which is a conscience effort on our part to not go crazy), but when they get 9 gifts from their aunts and uncles and grandparents it is hard not to love gifts. Shoot, I love getting gifts.
I looked around the tree and thought, "it sure doesn't look like a recession in the Gammichia world," and I know you guys probably went through the same thing. We can't stop. We don't know how to scale down. I am totally guilty of it so I am not putting all the blame on my wife.
I am going to stop there. I am having some major laptop problems. Every time I take my laptop home and use a different wireless system and then I bring it back to work it gets pissed.
It won't work. So my father and I fight for the remaining computer in the office. And it is so slow. It is like working on dial-up. And I have been so busy at work I have had to write up all my charts from home.
The computer guy is coming on Friday (at $75 an hour) to fix my issues.
I would have added all the photos but doing this is so painful today.
I was going to talk about my office Christmas party, but I will wait until Friday.
I will load up all the photos on Fridays blog.
I hope your Christmas/Holiday was good.
I hope work is going good for all of you...remember it is supposed to be like riding a bike.
And I hope to see you on Friday,
john




Monday, January 4, 2010

Bring Back Roman Numerals

OK, let's start the new year with a bit o' controversy. I want to jump headfirst into the great debate - "2010" how should it be pronounced? "Twenty-ten" or "Two-thousand-ten"? Any thoughts?

Personally, I think this would be a great time to revert to the Roman system "MMX" it could be pronounced "mix" - here, I'll use it in a sentence, "I think MMX is going to be a much better year than MMIX". Damn, that won't work. Those Romans had it so easy, they never even got to see the Ms in their empire. "Hey Claudius, what are your CDLXVII year's resolutions. . ."

Can you imagine your practice management software using roman numerals? That crown preparation appointment (dental code D MMDCCL) is going to take LXII minutes and cost $CMLIV.

On second thought, I vote for "Twenty-ten."

On the dental front, December was CRAAAAAAZZZZZZYYYYY. We did a month's worth of dentistry in 2 weeks. I stay open between Christmas and New Year's and with the holidays falling on Fridays this year we were open a lot. It is great from a production standpoint, but I would love for those patients to spread it out a little. Throw me a bone in November.

It was a good reminder to me, and I pointed it out to the staff, that the economy cannot be blamed for our scheduling issues. When the urgency is there, the patients are getting in and getting the work done. That urgency was provided by end-of-the-year benefits periods, but we as a staff need to create that urgency every month of the year. If a filling needs to be done, we need to make sure that the patient understands the importance of following through. MMX is going to be a year where we work on that.

Was it just me or was the first decade of the XXIst Century weird. I mean, a lot happened to me during this last decade, but it feels like a lost X years. Let me inventory: My law firm split, my son was born, I left the legal practice, I returned to college for dental prerequisites, the World Trade Center bombing, accepted to dental school, turned XXX, left family and friends to move to Kansas City, bought a house, Susan got a job up here, started school, school, school, school, moved across town, Susan got a different job, school, school, school, my daughter born, my nephew born, school, school, my brother dies, my grandma dies, take boards, my uncle dies, school, clinical boards, start my own dental practice, debt, debt, debt, debt, Susan starts her veterinary dental practice, debt, debt, debt, celebrate XVIth wedding anniversary, Christmas, New decade.

Now, I left a couple things out, but you get the gist of it. I'm ready for this next decade. I will turn XL, II of my kids will graduate high school (God willing), I will celebrate my XXV wedding anniversary, I will be debt-free, and it will (maybe) be the first decade of my life where I am not a full-time student. Maybe, I will even remember what it is like to sleep a full-night without panic attacks.

should be fun,

have a great day.

ric

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